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Social Emotion Recognition, Social Functioning, and Attempted Suicide in Late-Life Depression

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Objectives

Lack of feeling connected and poor social problem solving have been described in suicide attempters. However, cognitive substrates of this apparent social impairment in suicide attempters remain unknown. One possible deficit, the inability to recognize others' complex emotional states has been observed not only in disorders characterized by prominent social deficits (autism-spectrum disorders and frontotemporal dementia) but also in depression and normal aging. This study assessed the relationship between social emotion recognition, problem solving, social functioning, and attempted suicide in late-life depression.

Design, Participants, Measurements

There were 90 participants: 24 older depressed suicide attempters, 38 nonsuicidal depressed elders, and 28 comparison subjects with no psychiatric history. We compared performance on the Reading the Mind in the Eyes test and measures of social networks, social support, social problem solving, and chronic interpersonal difficulties in these three groups.

Results

Suicide attempters committed significantly more errors in social emotion recognition and showed poorer global cognitive performance than elders with no psychiatric history. Attempters had restricted social networks: they were less likely to talk to their children, had fewer close friends, and did not engage in volunteer activities, compared to nonsuicidal depressed elders and those with no psychiatric history. They also reported a pattern of struggle against others and hostility in relationships, felt a lack of social support, perceived social problems as impossible to resolve, and displayed a careless/impulsive approach to problems.

Conclusions

Suicide attempts in depressed elders were associated with poor social problem solving, constricted social networks, and disruptive interpersonal relationships. Impaired social emotion recognition in the suicide attempter group was related

Section snippets

OBJECTIVES

Suicide rates are the highest in old age in almost every country in the world. Yet, it is difficult to identify those at risk, since known risk factors, such as depression, pain, disability, or financial problems have limited predictive power.1, 2, 3 The role of deficits in cognitive abilities is a poorly understood part of the suicidal diathesis,4,5 especially in older adults.6 The failure to deal with social stressors may play a particularly important role in suicidal behavior, and indeed

METHODS

Ninety participants age 60 and older were recruited between June 2006 and October 2009: 24 depressed suicide attempters and 38 nonsuicidal depressed elders were recruited on an inpatient psychogeriatric unit and in a late-life depression clinic; 28 elders with no psychiatric history were recruited from University and community primary care practices. Depressed participants met criteria for major depressive disorder as determined by the Structured Clinical Interview of the Diagnostic and

STATISTICAL ANALYSES

Continuous measures were compared among the three groups using one-way analyses of variance (ANOVA); categorical data were compared with κ2 tests. All tests were two-sided. An analysis of covariance (ANCOVA) was conducted to compare the number of errors on the RME with age, sex, education, substance abuse, and DRS scores as covariates. Tukey Honestly Significant Difference (HSD) post-hoc tests were conducted when significant differences were detected among the groups. Within the attempter

Demographic and Clinical Characteristics

There were no statistical differences among the three groups in age, sex, race, marital status, level of education, MMSE, or EXIT scores (Table 1). There was no significant difference in sex distribution although we note that 61% of the elders with no psychiatric history were men versus 38% of attempters and 34% of nonsuicidal depressed participants. Attempters had significantly lower DRS scores than the two other groups. Levels of physical illness burden (CIRS-G scores) and intensity of

CONCLUSIONS

We identified a deficit in the recognition of complex social facial emotions in older suicide attempters compared to nonpsychiatric controls. However, this effect could not be disaggregated from reduced global cognition in suicide attempters. The performance of nonsuicidal depressed elders was intermediate between the two groups. There were several indicators of poor social functioning in suicide attempters: they reported a pattern of struggle against others, hostility in relationships, and a

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    • Cited by (0)

    Szanto, Dombrovski, and Houck do not have any conflict of interest. Clark and Sahakian are affiliated to the Behavioral and Clinical Neuroscience Institute, which is supported by a consortium award from the Medical Research Council (UK) and the Wellcome Trust. Clark and Sahakian consult for the Cambridge Cognition. Mulsant currently receives research support from the US National Institute of Mental Health, the Canadian Institutes for Health Research, Bristol-Myers Squibb, and Wyeth. During the past 5 years, he has also received research support or honoraria from Astra-Zeneca, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Janssen, Lundbeck, and Pfizer. He previously held stocks (all less than $10,000) of Akzo-Nobel, Alkermes, AstraZeneca, Biogen, Celsion, Elan, Eli Lilly, Forest, Orchestra Therapeutics, and Pfizer. Reynolds receives research support in the form of pharmaceutical supplies from Bristol-Myers Squibb, Pfizer, Eli Lilly, and Forest Laboratories.

    The authors thank Professor Baron-Cohen of the Autism Research Centre, University of Cambridge, for providing the Reading the Mind in the Eyes Test.

    This work was supported by a National Institute of Health K23 grant (MH070471) and R01 MH05436 and an American Foundation for Suicide Prevention Junior Investigator grant to K. Szanto and the P30 MH71944 and the UPMC Endowment in Geriatric Psychiatry for C. Reynolds.

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    Copyright © 2012 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.